FORM 1023-EZ for HABITUAL ROOTS INC

Field Data
EIN 84-2190456
Case Number EO-2019186-000073
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HABITUAL ROOTS INC
Organization’s Mailing Address 1348 GREEN OAKS LN APT N
City CHARLOTTE
State NC
ZIP 28205
Accounting period End 12
Primary contact name JUSTIN ERVIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUSTIN ERVIN
PRESIDENT/TREASURER
1348 GREEN OAKS LN APT N
CHARLOTTE NC 28205

Officer/Director/Trustee Two

KEVIN WONG
VICE PRESIDENT/SECRETARY
1348 GREEN OAKS LN
CHARLOTTE NC 28205

Officer/Director/Trustee Three

TIM WILLIS
BOARD MEMBER
1348 GREEN OAKS LN
CHARLOTTE NC 28205

Officer/Director/Trustee Four

ROBERT RICHARDS
BOARD MEMBER
1348 GREEN OAKS LN
CHARLOTTE NC 28205

Officer/Director/Trustee Five

JONATHAN MAYHORN
BOARD MEMBER
1348 GREEN OAKS LN
CHARLOTTE NC 28205

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/25/19
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B90 - Educational Services and Schools - Other
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JUSTIN ERVIN
Signature Title PRESIDENT/TREASURER
Signature Date 7/2/19

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